What is Plantar Fasciitis?
Plantar fasciitis is a condition caused by degradation and irritation at the root of the plantar fascia, a tissue found at the heel’s inner part. The plantar fascia is vital for the normal functionality of the foot and consists of three parts emerging from the heel bone. It helps to support the foot’s arch and contributes to shock absorption. Interestingly, despite ‘itis’ in its name suggesting inflammation, this condition doesn’t involve inflammatory cells.
It’s a common issue in the United States, with millions of people experiencing heel pain every year. The cause of plantar fasciitis is multifaceted, but it most often results from overuse or stress. It usually manifests as sharp, localized pain at the heel. Occasionally, a heel spur, or small bone projection, may be detected. It is challenging to treat plantar fasciitis, and patients often express dissatisfaction with most treatment methods. Most cases are managed with non-surgical treatments, but the recurring pain can be frustrating.
What Causes Plantar Fasciitis?
Plantar fasciitis is often caused by doing something too much, which leads to small tears in the plantar fascia – a band of tissue that connects the heel bone to the toes. Other things like injury or a mix of different factors can also trigger the condition. Some factors that increase the likelihood of developing plantar fasciitis are having either flat or high-arched feet, standing up or jumping for prolonged periods, and excessive inward or outward rolling of the feet when you walk or run.
Flat feet can lead to more strain where the plantar fascia begins, while high-arched feet can put additional strain on the heel because the foot is not very effective at turning outward or softening the impact of steps. Tense muscles in the calves or other muscles located at the back of the leg can worsen the situation by changing the normal way you walk.
Roughly half of the patients suffering from plantar fasciitis may also have bony outgrowths on the heel, called heel spurs, but these are not the reason for the condition. Plantar fasciitis is commonly linked with runners and older people, but other risk factors include being overweight, wear and tear of the fat pad on the heel, aging, jobs requiring long periods of standing, and weight-bearing activities. Plantar fasciitis has also been associated with certain types of arthritis, but for about 85% of cases, there are no known related general health factors.
Risk Factors and Frequency for Plantar Fasciitis
Plantar fasciitis, a leading cause of heel pain, isn’t tracked by age specifically. However, we estimate that about 1 million patient visits each year are for plantar fasciitis. This condition is responsible for around 10% of injuries among runners and 11% to 15% of all foot-related medical care. About 10% of the general population experiences plantar fasciitis, with the bulk of those cases (83%) being active working adults between the ages of 25 and 65. The condition is most prevalent in the population aged 40 to 60 years. Plantar fasciitis affects both feet in about one-third of cases. Interestingly, it’s more common in women than men, people aged 45 to 64 (as compared to 18 to 44), and people with a body mass index over 25 kg/m2. Among runners, the rate of plantar fasciitis can be as high as 22%.
- Plantar fasciitis is the main cause of heel pain.
- Each year, around 1 million visits to a doctor are due to plantar fasciitis.
- This condition represents about 10% of runner-related injuries, and 11% to 15% of all foot issues needing medical attention.
- Plantar fasciitis affects about 10% of the population.
- Most affected are active working adults, aged between 25 and 65.
- The peak age group for the condition is 40 to 60 years old.
- In about a third of cases, plantar fasciitis affects both feet.
- The condition is more often seen in women, people aged 45 to 64, and those with a body mass index over 25 kg/m2.
- Up to 22% of runners may suffer from plantar fasciitis.
Signs and Symptoms of Plantar Fasciitis
People usually come to the doctor complaining of a growing pain in the lower and inner part of their heel. In severe cases, this pain might spread up the foot. The sharp pain is often worst when taking the first few steps after getting out of bed in the morning. Extended periods of standing, or even sitting in severe cases, can make the pain worse. Interestingly, the pain often lessens when a person first starts walking or participating in sports, but then increases as the day’s activities continue.
Doctors can usually reproduce the pain by pressing down on the point where the plantar fascia (band of tissue that connects the heel bone to the toes) connects to the heel bone. Bending the foot and toes up towards the shin can also reproduce the pain. A special test called the windlass or Jack test involves causing pain by bending up the big toe, a sign that the plantar fascia is indeed inflamed.
- Progressive pain in the lower and inner part of the heel
- Pain that worsens with the first steps in the morning
- Pain that increases with extended standing or sitting
- Pain that decreases when first walking or participating in sports, then gets worse
- Pain caused by pressure on the plantar fascial insertion on the heel bone
- Pain caused by bending the foot and toes up
Additionally, the doctor might also check your gait (the way you walk) to look for any abnormalities that might contribute to the condition. Other conditions such as damaged fat pads in the heel, stress fractures, and nerve problems like tarsal tunnel syndrome should also be considered when diagnosing plantar fasciitis.
Testing for Plantar Fasciitis
Plantar fasciitis is typically diagnosed through a physical examination, but additional imaging tests may be necessary if the pain persists or if other injuries are suspected. X-rays and ultrasounds can detect changes in the soft tissues, such as thickening and swelling of the plantar fascia, as well as heel spurs. If the condition does not improve with standard treatments, an MRI may be recommended to identify more serious issues like muscle or bone tears, stress fractures, or bone and cartilage defects. Technetium scintigraphy is another diagnostic technique that can accurately identify inflammation and rule out stress fractures.
Treatment Options for Plantar Fasciitis
The first step in treating foot pain is to rest and avoid activities that cause discomfort. Using ice and anti-inflammatory medications can help reduce pain. Deep massage, shoe inserts, and stretching exercises can also provide relief. If the pain persists, more advanced treatments like shock-wave therapy or injections may be considered. Surgery is a last resort for chronic pain that doesn’t respond to other treatments. Preventative measures like stretching and wearing shock-absorbing shoes may help reduce foot pain, but more research is needed to confirm their effectiveness.
What else can Plantar Fasciitis be?
When a doctor is trying to diagnose foot pain, they’ll consider a number of possible causes, including:
- Calcaneus injury (an injury to the heel bone)
- An infection
- Sickle cell bony pain (pain in the bones related to sickle cell disease)
- Bone contusion (a bruise of the bone)
- Neuropathic pain (pain caused by damage to the nerves)
- Tendinitis (inflammation of a tendon)
- Osteoporosis (bone loss)
- Malignancy (cancer)
Taking into consideration all these alternative possibilities and undergoing proper medical tests, allows for an accurate diagnosis and effective treatment.
What to expect with Plantar Fasciitis
About three-quarters of cases get better on their own, typically within a year. Around 5% of people with this condition might require surgery, but this doesn’t always guarantee positive results. Keep in mind that even with treatment, it can still take weeks or months for symptoms to fully disappear.
Plantar fasciitis can significantly impact a person’s life because it often requires taking time off from physically demanding jobs or sports. In certain cases, some people may need to use a mobility aid to keep weight off the affected area.
Possible Complications When Diagnosed with Plantar Fasciitis
Some complications that might arise from plantar fasciitis are:
- Tendon rupture, mainly if corticosteroid injections are used
- Death of the fatty tissue under the heel (fat pad necrosis)
- Flattening of the foot arch
Preventing Plantar Fasciitis
Patients are often recommended to regularly stretch their feet, most importantly before and after working out. The right kind of footwear is also essential; shoes that provide good support and cushioning can lower the risk of foot conditions like plantar fasciitis. Furthermore, patients should slowly build up their level of physical activity to prevent injuries from overuse and to keep their weight in a healthy range.